Hooves on the ground

It’s been a while since I’ve reviewed a book, not because I’ve not been reading but because I’ve not been feeling social and like sharing anything, so it’s possibly a very good sign that the first book that I go to review is one which I had dragged out to find a diagram for a bodybuilding pal.

It has, as the title suggests, two major components – Posture and Pain, and Testing and Function – and both of these sections are great. They can be read individually, but being a layman I ended up cross-referencing from one to the other a lot – Reading and observing posture, then finding the diagrams for the individual muscle groups mentioned, and testing them for length/shortening and weakness/strength. One of my favourite things about this book is that for a lot of things it does use cartoons, not photographs, so it’s a lot easier to see the movement and shape of muscles when the one that you’re observing is highlighted in red and the others are all just outlines, as compared to if they’re photographs or more exact diagrams.

The posture section shows, as well as the “problematic” postures, the explanation for how each of them affects the muscles underneath, and which muscles thus need to be strengthened and which need to be counterbalanced in order to correct the posture (Not just for aesthetic reasons either, it explains how the various postures can translate into muscle weaknesses and pain later in life). It’s all extremely well laid out and presented in accessible, readable language, with photographs and diagrams, and technical terms explained in a glossary.

A long, extremely useful section of the book takes each of the muscles in turn, describes its placement and function, and also how to both flex and relax the muscle as far as possible – This is good for a handful of things; Finding relaxed or comfortable configurations for individual sore muscles, devising exercises to specifically strengthen individual muscle groups, and working out which muscles are compensating and “taking over” for other muscles during a movement, which is extremely common in hypermobile people; Archetypally, using ones latissimus dorsi to “stabilise” arm movements that should mostly be affecting the biceps, resulting in soreness and inefficient movements, but the same applies to basically any movement where a larger muscle can compensate for weakness in a smaller group. Near the end of the section is a series of diagrams of the superficial nerves, which is also extremely useful for trying to localise hard-to-describe pains.

Throughout the book there are worksheets and explanations of how to record a patient’s performance and presentation, which are extremely useful when you’re looking at yourself and trying to objectively assess how bad something is, or how good it is.

As with most textbooks, this is a book to drop in and out of, focusing on the system or the movement that you need. I’ve been using it mostly to work out which muscle groups I need to address more in my workouts, and to make sure that the things that I do to “help” when I’m relaxing aren’t actually making things worse in the long run.

I’d definitely reccommend this book, possibly as the first book to get when assessing your own body’s condition especially in relation to the pain that comes with hypermobility. As much as doctors are often too quick to turn to “deconditioning” as an answer to everything, there is absolutely power in knowing where all your muscles are and how to use them correctly, and thus to know which ones are underperforming and need work.

Disclaimer: Nothing said above is intended as a substitute for qualified medical advice, or to supersede the advice of a qualified physician. This is my personal review of my experiences with a book, as a layman. I am not a medical professional, of any kind, and any health issues should be discussed with a doctor or other appropriate professional.

This is exactly what it sounds like; A compilation of colour photographs, CT-scans and MRIs of the human body, laid out by body part (Head, neck, trunk, thoracic organs, abdominal organs, urogenital and reproductive, upper limb, lower limb).

Now, most of the book is going to be no direct use; the sections on the internal organs, for example. Honestly, most of the book is probably not very much practical use at all, in the scope of dealing with hypermobility. It’s meant as a companion to a dissection lab, allowing students to view the structures that they’ll find in their cadaver in a flat, easy-to-understand form.

My use for it is in placing exactly which structures have gone wrong – With a combination of following the sore or tense bits of muscle to find the attachment points, then viewing the cadavers to see exactly how it interacts with the things around it, then applying targetted manipulation to it to make it hurt less, whether that be a movement from Maitland, an exercise to isolate that muscle group, vibration, TENS (one pad on each end of the muscle, much more useful than making every random muscle around it go wrong) or anything else.

It’s also useful for working out if something is luxated or not, and if it is luxated, how to put it back. This might only work if you’re on the undernourished side – I can feel inside various processes with a slight pressure, which wouldn’t work if there was more muscle or fat in the way – but I’ve found it to be a really useful guide to exploring the glenoid process, and to working out the non-intuitive bits of pain relief (Example – sometimes the best way to deal with a pain over the clavicle is to massage down under the scapula. Or on the ribs.) and the best positions to get into to reduce the strain on individual bits of tissue.

Incidentally, I find it useful to use this book along with a Mr Thrifty, A 1/4th scale desk skeleton, fully articulated, and onto which I’ve painted some of the major points of attachment for the muscles of the limbs, since it helps with the spacial reasoning (To whit, I can move the limbs around, and see what stretches the muscles, what puts the least pressure on the joints, etc).

The pages themselves are well laid-out, most having a large photograph of the body part being examined, partially dissected and with the major structures labelled, and the dissection itself is described – What’s been removed, which angle it’s being viewed from, and (in the case of arms) if it’s pronated or supinated. Next to these there’s usually a small diagram showing interesting points of the structures involved, or demonstrating a movement, and they’re an even more stripped-down way of looking at the same structures.

I find that, above all else, it’s a very comforting book. Seeing the sheer weight of the bones of the knee, and the sharp hook of the olecranon, it makes my limbs feel a lot more solid. And, as the introduction says, we are reminded of “How precisely, beautifully and admirably the human body is constructed”.

Disclaimer: Nothing said above is intended as a substitute for qualified medical advice, or to supersede the advice of a qualified physician. This is my personal review of my experiences with a book, as a layman. I am not a medical professional, of any kind, and any health issues should be discussed with a doctor or other appropriate professional.

The first notable thing about the edition of Peripheral Manipulation that I have are the two prefaces; One to the first (1970) and one to the second (1977) edition.

The preface to the first edition begins with “Treatment of painful peripheral joints by passive manipulation has become almost a forgotten art amongst physiotherapists” and goes on to talk about how generally, exercise is a more popular prescription. The preface to the second begins with “Manipulation is now accepted fairly generally as a routine part of medicine.” and talks about a massive sea-change in the practice of physiotherapy. Amusingly, at my first set of physio sessions in 2007 I was treated to a lot of hands-on manipulation, most notably having my pelvis realigned by a lot of stretching and twisting. It hurt, but it stuck. In 2013, on my second set of physio sessions for the same condition, I was set exercises with plenty of touching and correcting and holding parts of me in place. In 2015, my physio set me exercises, but was reluctant to touch me or even look at me.

In short, physiotherapy has fashions, and this book caters to one of them admirably. From my perspective as a patient, both exercises (for strength and conditioning) and manipulation (for relaxation and education of what the correct ranges of motion for each joint are) are really valuable, and although exercises are easy enough to find or deduce, manipulations are much less intuitive.

“Part 1, Theory” is the most important for knowing what and how to do, and for explaining how to assess exactly what a problem is and to put it into clinical terms; It contains a few flowcharts on how to take a patient history and assess the type of pain or stiffness, and explains how to apply a technique at the appropriate level of vigour. It’s a good read, both for working out how to apply the manipulations safely and appropriately to yourself or to another person, and also to understand the kind of guidelines that are appropriate for a physiotherapist to work within.

“Part 2, Joint Techniques and Management” is the bulk of the book, being a collection of ways to move each joint passively, laid out by joint, top to bottom.

The pages for each joint are slightly confusing at first, being laid out acros the double-page spread, rather than left hand page (top to bottom) then right hand page (top to bottom), but that’s more of a minor quibble with how I prefer my iinformation to be set out, and it does mean that paragraphs can be folded up small enough to fit in larger diagrams and their annotations.

Each one starts with a table of examinations, both active and passive, to work out where the pain or stiffness is, and what brings it on. These use a fair bit of technical terminology, which are all abbreviated (the abbreviations are keyed in one of the Appendices) but for a reader who isn’t confident on fairly subject-specific terms for the body plan or movements, it’d be worthwhile to look up the terms online and then annotate; It is a book intended for physiotherapists and students, rather than laypeople, but it’s set out so accessibly that with just a bit of annotation, it’d be very readable to anyone with more than a passing interest in their condition.

What makes it extremely readable is the diagrams – They’re set out extremely simply, with a number of different passive motions per joint, which can be applied as indicated. Each movement is described in detail, around the illustration, with explanations of the method and desired outcomes below it. I found it best to bookmark the ones that I needed most often, and then try them when the joint was not stiff or painful before trying them “in action”.

Of course, this book does not purport to treat subluxations or dislocations – One can’t do any of these movements straight onto a subluxed joint (or if one can, they don’t do what they’re intended to do, and might cause damage) – but I’ve found them to be good for relaxing and settling and generally making comfortable anything that’s stiff or in spasm or just generally sore and unpleasant. Many of the techniques focus on the passivity of the patient, so have detailed instructions to the person performing the technique to allow them to isolate the joints needed and take the weight of the limb without the patient needing to use their own strength.

The final section of the book is “Part 3, Application” which is largely about recording and tracking progress over a course of treatment, and explaining points made earlier in the book in greater detail. This is useful for all sorts of reasons – Not least just to have some objective measures of progress over time, either for personal use, or to show to future physios.

In short: It’s a useful book, either as an educated layman trying to work out things which will make the pain stop, or for working out what a physiotherapist was trying to get at in session. I can’t say that it’s definitely useful for everyone, and I wouldn’t tell people to try to use it as a substitute for proper care from a physiotherapist, but as a tool for educating oneself as a patient, it’s a good place to start.

Disclaimer: Nothing said above is intended as a substitute for qualified medical advice, or to supersede the advice of a qualified physician. This is my personal review of my experiences with a book, as a layman. I am not a medical professional, of any kind, and any health issues should be discussed with a doctor or other appropriate professional.